Credentialing Specialist

Job Details

Description

Harbor is seeking a Credentialing Specialist to join our Toledo team! This position is responsible for the day-to-day operations of credentialing new and established health care providers and maintenance of clinical information and practice locations with payer sources in a timely and complete manner.

Position is full-time, 40 hours per week.

Education/Experience/Other Requirements

• Associate degree in administration, health or behavioral science field preferred.
• Behavioral Health experience preferred.
• Must have knowledge of medical terminology and at least two years of related experience.
• Must have excellent communication skills, both verbal and written.
• Must demonstrate an ability to meet deadlines in a multi-functional task environment.
• Requires excellent organizational skills, an operational knowledge working with word processing, spreadsheets, data entry, electronic health record and practice management systems, and other computer related skills.
• Must at all times maintain efficiency and timeliness in all daily activities.
• Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process.
• Provides optimal customer service to meet the organization’s expectations.
• Must at all times be able to maintain the confidentiality of privileged information.
• Excellent project management with ability to follow up on projects and meet deadlines.
  
  

Essential Job Competencies/Primary Duties

• Assists the Credentialing Coordinator in the day to day operations
• Performs the appropriate credentialing and privileging processes for both new and established health care providers in a timely and complete manner.
• Communicates with new staff in helping them to acquire their NPI, and of the sequential steps needed to begin the credentialing enrollment process, through completion.
• Provides third-party technical support to Harbor staff providing services under contract with managed care/insurance organizations and with other units within Harbor.
• Assists clinical staff in completing needed credentialing information.
• Maintains credentialing information in National Database and SmartCare.
• Works with many individuals to acquire necessary materials and information, including but not limited to: physicians, facility staff, professional staff, physician’s office staff and hospital staff.
• Performs relevant data entry into the database to ensure consistency and integrity of the data.
• Processes appropriate queries and assists providers in renewing expired credentials and licensure, or any appropriate regulatory credentialing requirements and maintains documentation in the database.
• Monitors collection of all information received; follow up on missing items and/or incomplete forms, submit follow up requests for verifications as needed.
• Ensures that all credentials are current at all times.
• Maintains all credential files ensuring that all correspondence in the credentialing process is accurately filed; is knowledgeable and current on the process and legal/regulatory requirements.
• Maintains clinic information and practice locations with payers.
• Provides optimal customer service to meet the organization’s expectations.
• Provides support to executive management in relation to credentialing.
• Assists in maintaining payer portals, information, and billing systems.
• Keeps current with trends and developments related to essential job competencies, and demonstrates continuous growth.
• Performs other duties and works on special projects as requested.
  
  

About Harbor

• A leading provider of mental health and substance use treatment for over 100 years
• 350+ clinical staff serve over 24,000 clients across multiple locations and in the community each year
• Services ranging from counseling, pharmacological management, primary care, psychological testing, case management, substance use treatment, residential services, vocational program, and more!
  
  

Why Work for Harbor?

Benefits

It is fast-paced and challenging, but you will have a lot of fun in the process. You will have the opportunity to meet other motivated individuals who are also making a positive impact at our company. Harbor is committed to investing our resources in you! Some benefits of working with Harbor include:

• Medical, dental, and vision coverage
• Retirement plan with company match
• Generous paid time off, sick time, and paid holidays
• Tuition and professional license reimbursement programs
• Clinical supervision hours offered
• Employee referral bonuses
• Ability to make a difference in your community!